Quantifying <i>T</i> <sub>2</sub> relaxation time changes within lesions defined by apparent diffusion coefficient in grey and white matter in acute stroke patients

Damion, Robin A.; Knight, Michael; McGarry, Bryony L.; Bosnell, Rose; Jezzard, Peter; Harston, George; Carone, Davide; Kennedy, James; Tawil, Salwa El; Elliot, Jennifer; Muir, Keith W.; Clatworthy, Philip; Kauppinen, Risto A.

doi:10.1088/1361-6560/ab1442

Cited by 5 publications

(18 citation statements)

References 31 publications

(80 reference statements)

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“…First, it was a pilot study with a modestly sized unselected cohort of people with stroke symptoms, consisting of strokes of varying size and severity, that occurred in different vascular territories and tissue types. Recent results suggest the time dependency of T 2 during the first 9 hours of stroke does not differ between grey and white matter, 18 but it is currently unclear whether this is true for different vascular territories. A previous study 27 found lesion size to be a mediating factor in the relationship of DWI image intensity ratios with time from onset.…”

Section: Discussionmentioning

confidence: 99%

“…25,47,48 The T 2 relaxation time also demonstrated higher overall ability at differentiating between scans performed before and after 3 hours from ischemia onset in rat models. 25 Patient studies have shown the T 2 relaxation time to have a strong linear relationship with time from symptom onset [16][17][18] Figure 6. PRG curves and AUPRG curves from the subcohort of patients with additional FLAIR scans.…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, in our recent analysis of the patient cohort studied here, we found that the size of ADC lesions increased in 11 of 19 thrombolysed patients between initial (<9 hours onset) and follow-up scans (24+ hours), suggesting that ADC remained low long after rtPA, and thus rtPA would have had minimal or no effect on T 2 in the lesion. 18 However, to truly support this point, more information about blood flow would be needed, and a future study, including patients who undergo MRI before reperfusion therapies, is warranted. Regarding thrombolysis before MRI examination, it is well known in clinical practice that rtPA administration may make the previously ischemic lesion DWI/ADC negative.…”

Section: Discussionmentioning

confidence: 99%

“…Patient studies have shown the T 2 relaxation time to have a strong linear relationship with time from symptom onset 16 - 18 and high overall ability at distinguishing between patients within and beyond the thrombolysis time window. 17 , 19 In this study, the AUC of the T 2 relaxation time ratio shows that 77% of the time, a randomly selected patient scanned within 4.5 hours of symptom onset had a lower T 2 than a randomly selected patient scanned at a time later than 4.5 hours.…”

Section: Discussionmentioning

confidence: 99%

“…Image processing and analysis steps are illustrated in Figure 1 and described in detail below. These methods were developed and implemented by Knight et al 19 and Damion et al, 18 and programs used included MATLAB release 2016b (The MathWorks, Inc, Natick, MA), FSL (FMRIB, Oxford, UK), MANGO version 4.1 (Research Imaging Institute, UT Health Science Center, San Antonio, TX) and SPM12 (Wellcome Trust Centre for Neuroimaging).…”

Section: Methodsmentioning

confidence: 99%

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A Comparison of T₂ Relaxation-Based MRI Stroke Timing Methods in Hyperacute Ischemic Stroke Patients: A Pilot Study

McGarry

Damion

Chew

et al. 2020

J Cent Nerv Syst Dis

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Background: T2 relaxation-based magnetic resonance imaging (MRI) signals may provide onset time for acute ischemic strokes with an unknown onset. The ability of visual and quantitative MRI-based methods in a cohort of hyperacute ischemic stroke patients was studied. Methods: A total of 35 patients underwent 3T (3 Tesla) MRI (<9-hour symptom onset). Diffusion-weighted (DWI), apparent diffusion coefficient (ADC), T1-weighted (T1w), T2-weighted (T2w), and T2 relaxation time (T2) images were acquired. T2-weighted fluid attenuation inversion recovery (FLAIR) images were acquired for 17 of these patients. Image intensity ratios of the average intensities in ischemic and non-ischemic reference regions were calculated for ADC, DWI, T2w, T2 relaxation, and FLAIR images, and optimal image intensity ratio cut-offs were determined. DWI and FLAIR images were assessed visually for DWI/FLAIR mismatch. Results: The T2 relaxation time image intensity ratio was the only parameter with significant correlation with stroke duration ( r = 0.49, P = .003), an area under the receiver operating characteristic curve (AUC = 0.77, P < .0001), and an optimal cut-off (T2 ratio = 1.072) that accurately identified patients within the 4.5-hour thrombolysis treatment window with sensitivity of 0.74 and specificity of 0.74. In the patients with the additional FLAIR, areas under the precision-recall-gain curve (AUPRG) and F1 scores showed that the T2 relaxation time ratio (AUPRG = 0.60, F1 = 0.73) performed considerably better than the FLAIR ratio (AUPRG = 0.39, F1 = 0.57) and the visual DWI/FLAIR mismatch (F1 = 0.25). Conclusions: Quantitative T2 relaxation time is the preferred MRI parameter in the assessment of patients with unknown onset for treatment stratification.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

See 3 more Smart Citations

A Comparison of T₂ Relaxation-Based MRI Stroke Timing Methods in Hyperacute Ischemic Stroke Patients: A Pilot Study

McGarry

Damion

Chew

et al. 2020

J Cent Nerv Syst Dis

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Effect of Optimized Emergency Care on Treatment Rate and Prognosis of Elderly Patients with Acute Stroke in Emergency Department: A Systematic Review and Meta-Analysis

Liang

2022

Computational and Mathematical Methods in Medicine

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Objective. This research was to detect the treatment rate and prognosis of elderly patients with acute stroke in emergency department by the optimization of emergency care applying meta-analysis. Methods. The online databases including PubMed, EMBASE, ScienceDirect, Cochrane Library, China knowledge Network Database (CNKI), China VIP Database, Wanfang Database, and China Biomedical Literature Database (CBM) were searched. The retrieval time limit was set from the establishment of the database to the present. The data were extracted independently by two investigators. The bias of per publication was assessed following Cochrane manual 5.1.0 standard. RevMan5.4 statistical software was used to analyze the collected data by meta. Results. The 8 randomized controlled trials included in this meta-analysis all reported patients’ baseline status. The meta-analysis of the rescue time of the study group and the control group ( CH 2 = 1507.80 , df = 4 , P ≤ 0.001 , and I 2 = 100 % ) showed that the emergency nursing with optimized emergency procedures can shorten the rescue of elderly acute stroke patients in the emergency department time. There are 6 literatures reporting the case fatality rate ( Ch i 2 = 1.12 , df = 5 , P = 0.95 > 0.05 , and I 2 = 0 % ), and the death rate of the study group was not higher than that of the control group ( Z = 4.4 and P < 0.0001 ). The use of optimized first aid can reduce mortality in elderly patients with acute stroke. Six articles on disability rate reported the heterogeneity of disability rate ( CH 2 = 2.88 , df = 5 , P = 0.72 > 0.05 , and I 2 = 0 % ), indicating that the disability rate in the study group was lower than that in the control group ( Z = 3.91 and P < 0.0001 ), indicating that emergency nursing by optimizing emergency procedures can reduce the disability rate of elderly stroke patients in emergency department. Conclusion. Optimizing the emergency care process can effectively improve the emergency rate and prognosis of elderly patients with acute stroke in emergency department; however, further research with higher methodological quality and longer intervention time are needed to verify later.

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The effect of cerebral blood perfusion on the correlation between cerebral stroke onset time and synthetic T2 mapping: a pilot study

Wang¹,

Bie²,

Lü³

et al. 2023

Quant Imaging Med Surg

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Background: In patients with acute stroke with an unknown onset time, the T2 relaxation time (qT2) in the region of diffusion restriction is associated with the time from symptom onset. We hypothesized that cerebral blood flow (CBF) status assessed using arterial spin labeling magnetic resonance (MR) imaging would influence the association between qT2 and stroke onset time. The purpose of this study was to preliminarily investigate the effects of diffusion-weighted imaging-T2-weighted fluid-attenuated inversion recovery (DWI-T2-FLAIR) mismatch and T2 mapping value changes on the accuracy of stroke onset time in patients with different CBF perfusion statuses.Methods: A total of 94 patients with acute ischemic stroke (symptom onset time ≤24 h) admitted to the Liaoning Thrombus Treatment Center of Integrated Chinese and Western Medicine, Liaoning, China, were enrolled in this cross-sectional retrospective study. MR image compilation (MAGiC), DWI, 3-dimensional (3D) pseudo-continuous arterial spin labeling perfusion (pcASL), and T2-FLAIR images were acquired. The T2 map was directly generated from MAGiC. The CBF map was assessed using 3D pcASL.Patients were divided into the good CBF group (CBF >25 mL/100 g/min) and the poor CBF group (CBF ≤25 mL/100 g/min). The T2 relaxation time (qT2), T2 relaxation time ratio (qT2 ratio), and T2-FLAIR signal intensity ratio (T2-FLAIR ratio) between the ischemic and nonischemic region of the contralateral side were calculated. The correlations between the qT2, qT2 ratio, T2-FLAIR ratio, and stroke onset time were statistically analyzed in the different CBF groups.Results: In DWI-restricted areas, the time from symptom onset correlated with the qT2 and T2-FLAIR ratio. We identified an interaction between this association and CBF status. In the poor CBF group, stroke onset time most significantly correlated with the qT2 ratio (r=0.493; P<0.001), followed by the qT2 (r=0.409; P=0.001) and the T2-FLAIR ratio (r=0.385; P=0.003). In the total patient group, the stroke onset time moderately correlated with the qT2 ratio (r=0.438; P<0.001) but weakly correlated with the qT2 (r=0.314; P=0.002) and the T2-FLAIR ratio (r=0.352; P=0.001). In the good CBF group, no obvious correlations were found between stroke onset time and all MR quantitative indicators. Conclusions:In patients with reduced cerebral perfusion, the stroke onset time correlated with changes in the T2-FLAIR signal and qT2. The stratified analysis showed that the qT2 ratio had a higher correlation with stroke onset time than with the qT2 and T2-FLAIR ratio. of the lesion was quantified with the MAGiC technique (26,27), and the CBF values of the lesion area were quantified with the 3-dimensional (3D) pseudo-continuous arterial spin labeling perfusion (pcASL) technique (28-32).We present the following article in accordance with the STROBE reporting checklist (available at https://qims. amegroups.com/article/view/10.21037/qims-22-991/rc). Methods Patient selectionThis study was conducted in accordance with the Declaration of Helsink...

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Quantifying T ₂ relaxation time changes within lesions defined by apparent diffusion coefficient in grey and white matter in acute stroke patients

Abstract: Quantifying T 2 relaxation time changes within lesions defined by apparent diffusion coefficient in grey and white matter in acute stroke patients. Physics in Medicine and Biology, 64(9), [095016].

Cited by 5 publications

References 31 publications

A Comparison of T₂ Relaxation-Based MRI Stroke Timing Methods in Hyperacute Ischemic Stroke Patients: A Pilot Study

A Comparison of T₂ Relaxation-Based MRI Stroke Timing Methods in Hyperacute Ischemic Stroke Patients: A Pilot Study

Effect of Optimized Emergency Care on Treatment Rate and Prognosis of Elderly Patients with Acute Stroke in Emergency Department: A Systematic Review and Meta-Analysis

The effect of cerebral blood perfusion on the correlation between cerebral stroke onset time and synthetic T2 mapping: a pilot study

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Quantifying T 2 relaxation time changes within lesions defined by apparent diffusion coefficient in grey and white matter in acute stroke patients

Abstract: Quantifying T 2 relaxation time changes within lesions defined by apparent diffusion coefficient in grey and white matter in acute stroke patients. Physics in Medicine and Biology, 64(9), [095016].

Cited by 5 publications

References 31 publications

A Comparison of T2 Relaxation-Based MRI Stroke Timing Methods in Hyperacute Ischemic Stroke Patients: A Pilot Study

A Comparison of T2 Relaxation-Based MRI Stroke Timing Methods in Hyperacute Ischemic Stroke Patients: A Pilot Study

Effect of Optimized Emergency Care on Treatment Rate and Prognosis of Elderly Patients with Acute Stroke in Emergency Department: A Systematic Review and Meta-Analysis

The effect of cerebral blood perfusion on the correlation between cerebral stroke onset time and synthetic T2 mapping: a pilot study

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Quantifying T ₂ relaxation time changes within lesions defined by apparent diffusion coefficient in grey and white matter in acute stroke patients

A Comparison of T₂ Relaxation-Based MRI Stroke Timing Methods in Hyperacute Ischemic Stroke Patients: A Pilot Study

A Comparison of T₂ Relaxation-Based MRI Stroke Timing Methods in Hyperacute Ischemic Stroke Patients: A Pilot Study